[Total knee arthroplasty with bicruciate preservation: Comparison versus the same posterostabilized design at eight years follow-up].
OBJECTIVE
The purpose of this study was to determine the functional, clinical and radiographic results obtained with total knee arthroplasty (TKA) preserving both cruciate ligaments using the Hermès prosthesis with a fixed plateau. Mid-term results at eight years mean follow-up were compared with the outcome achieved at the same follow-up with posterior-stabilized (PS) Hermès TKA with a fixed bearing.


METHODS
The results of a continuous series of 41 TKA with bicruciate preservation implanted between 1991 and 1994 with and extra-articular distractor were analyzed at one and eight years follow-up using the IKS scores and radiographic findings. A change in the medial femoral and tibial angles greater than 2 degrees was considered to indicate implant loosening. Results were compared with those of a continuous series of TKA with PS knees implanted during the same period without a distractor and with independent bone cuts. The patients and operated knees were not different between the two groups: femoral and tibial implants were cemented in the large majority of knees with press-fit metal-backed patellar implants and comparable postoperative alignment (179 degrees ).


RESULTS
The knees with the TKA bicruciate preservation were painful (37.6%) and exhibited limited mobility (106 degrees ) from the first postoperative year, but the function score was good (80.8 points). Four tibial implants exhibited varus displacement greater than 2 degrees (mean 6.5 degrees ) and six femoropatellar changes were noted (five with lateral displacement of the patella on a non-cemented patellar implant). The knees with a posterior-stabilized TKA were almost all pain-free (44.3 points) and exhibited better range of motion (113.8 degrees ). Among the PS designs, there was the same number of tibial loosenings which were favored, as for the bicruciate preservation TKA, by excessive frontal laxity in extension at one year. Femoropatellar modifications appeared to be less common with the posterior PS knees (one event). There was no measurable polyethylene wear.


CONCLUSIONS
The good clinical and radiological results obtained by Cloutier, who used the same distractor for the same TKA implants with bicruciate preservation, suggest that the less favourable clinical results and the radiographic modifications of the patellofemoral component, which were more frequent in our bicruciate preserved implants, can be explained by an inadequate use of the distractor. By creating greater ligament tension (which we attempted to achieve), the independent bone cuts do not allow perfect respect of the dynamics of the cruciate ligaments compromising the frontal femoropatellar mechanics.


CONCLUSIONS
The risk of prosthetic loosening is not greater with TKA bicruciate sparing designs than with PS knees when the postoperative frontal laxity and the frontal realignment are satisfactory. They enabled better function but greater operative precision is required to achieve pain-free knees with a good range of motion.
Goutallier
D
D
Faculté de médecine de Créteil (Paris-12), hôpital Henri-Mondor (Assistance publique-Hôpitaux de Paris), France. daniel.goutallier@hmn.ap-hop-paris.fr
Manicom
O
O
Van Driessche
S
S
D000368:Aged; D016118:Anterior Cruciate Ligament; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016119:Posterior Cruciate Ligament; D011446:Prospective Studies; D011474:Prosthesis Design; D013997:Time Factors